title: Mediastinal seminoma presenting as superior vena cava syndrome and tracheal obstruction.
abstract: Malignant germ cell tumours of the mediastinum are rare, presenting mostly in young males. These are bulky tumours, mostly intrathoracic, infiltrating into adjacent structures early in the growth process. Patients may present with symptoms of compression. Occasionally, mediastinal adenopathy and superior vena cava (SVC) syndrome may occur. We discuss a case of a 19 year old boy with six weeks history of progressively worsening shortness of breath and mid-sternal chest heaviness and one month history of swelling of the face and upper limbs. The entire face and upper extremities were grossly oedematous with engorged veins suggesting SVC syndrome. CT scan chest showed a large mediastinal mass 18 x 24 cm extending from the superior mediastinum to the mid pericardial area. The trachea was extrinsically compressed to almost 80% at its distal portion. Mass was resected completely. Post operative course was unremarkable. The final histopathology showed a fibrotic mass with no viable tumour. Surgery followed by radiation therapy has been the usual initial treatment with multimodal chemotherapy showing remarkable results.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Aga Khan University, Karachi, Pakistan.
authors.forename: Saulat Hasnain
authors.initials: SH
authors.lastname: Fatimi
authors.forename: Basma
authors.initials: B
authors.lastname: Shahid
authors.forename: Hashim Muhammad
authors.initials: HM
authors.lastname: Hanif
authors.forename: Marium
authors.initials: M
authors.lastname: Muzaffar
mesh_terms: D000402:Airway Obstruction / Q000000981:diagnostic imaging / Q000209:etiology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy; D018239:Seminoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D056346:Sternotomy; D013479:Superior Vena Cava Syndrome / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D014133:Tracheal Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin